Knee osteoarthritis: steroid plus tenoxicam more effective than monotherapy

Takeaway

• In patients with knee osteoarthritis (OA), a combination of intra-articular corticosteroid and tenoxicam was more effective for a long period in reducing pain and improving functional recovery compared with tenoxicam and triamcinolone monotherapy.

Why this matters

• Previous studies have reported that the combination of non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids shows synergistic effects.

Study design

• 90 patients with knee OA were randomly assigned to receive intra-articular tenoxicam (n=30), triamcinolone (n=30) and triamcinolone plus tenoxicam (n=30).
• Pain severity (visual analogue scale [VAS]) and pain, stiffness and physical functioning (Western Ontario and McMaster Universities Arthritis Index [WOMAC]) were evaluated at baseline and 1, 3 and 6 months.
• Funding: None disclosed.

Key results

• Triamcinolone plus tenoxicam group vs tenoxicam and triamcinolone group had significant improvement in:
  • VAS at:
    • 1 month (0.33±0.47 vs 2.27±0.98 and 1.37±1.21),
    • 3 months (0.93±0.98 vs 6.73±1.14 and 6.87±1.35), and
    • 6 months (1.97±1.12 vs 7.03±0.80 and 7.27±0.86; P<.001 for all).
  • WOMAC at:
    • 1 month (6.67±0.95 vs 10.83±2.61 and 8.83±2.70),
    • 3 months (7.87±1.96 vs 30.33±5.93 and 30.80±7.70), and
    • 6 months (10.43±3.70 vs 31.37±4.38 and 32.83±4.87; P<.001 for all).
• After 1 month, VAS and WOMAC scores significantly decreased in all 3 groups compared with baseline (P<.01).
• Steroid plus tenoxicam group had significant improvement in VAS and WOMAC vs only tenoxicam/triamcinolone group at 3- and 6-month follow-up (P<.01).

Limitations

• Small sample size.
• Study did not include a control group, oral NSAIDs group and long-term outcome of the combination and monotherapy.